BBC One tonight: Poor America

Rupert_Bear

After watching that programme what have the whinging brits got to moan about.

Kennyboy66

Generali wrote: »

Do you know of a country with this sort of system? I can think of a couple but it ain't the NHS.

No 'free' system of healthcare can deliver care efficiently as if everything is priced at zero there is no difference between spending hundreds of thousands on a treatment and spending tens of pounds on a different treatment, perhaps on a different patient.

A system that imposes some costs on patients will always be more efficient. The Aussie system is a particularly fine example although there are others I believe. The NHS is expensive and inefficient and can never be anything else.

Australians and British spend broadly the same amount overall on heath care, whether provided by the state, privately or via a charity (8.5% of GDP vs 8.4% of GDP - link) despite Australia facing great difficulties providing health cover to a part of her population because of their geographical spread.

The life expectancy at birth for an Aussie is 16 months higher than for a Briton; infant mortality rates are 16% higher in the UK than Aus; mortality 'amenable to health care' (that is deaths that could have been prevented by better treatment) are 47% higher in the UK than in Aus.

Rather than compare the UK's system to another failing one, it would be better to compare it to one that is succeeding!

I'd have thought that was trivial compared to the fact that the median age in the UK is 3 years older than that of Australia (2010). The proportion of over 65's in Australia 13.6%, in the UK it 16.8%

A huge difference when health costs are skewed to the the very young and the old.

In addition, amenable to health care does not just merely mean preventable by better treatment. It extends to death (under 75) by factors such as alcohol, tobacco and obesity.

Kennyboy66

vivatifosi wrote: »

On the subject of drug companies - though not the US so apologies for going off on a tangent - there's an interesting article being run on Sky News this morning about the generics manufacturers in India. AIUI (and I'm a bit doped up at the moment) in order for India to trade more freely with the EU, the EU has demanded a clampdown on these generic companies because they are basically bootlegging the patented drugs invented by Western Companies. However the argument is that there is a massive human cost in doing this as these drugs are helping people stay alive.

The commission argues that life saving drugs aren't affected, but those on the street and protesting are arguing that retrovirals are included. It would probably be worth digging deeper into to find out where the truth lies. It's also a great shame that big drug companies aren't doing more to ensure access within the developing world for those who need it as there is clearly a need.

I think (very broadly) the drug comanies can accept some generic drugs being used in Africa and other 3rd world areas.

The problem becomes when those drugs leak back into 'wealthy' markets, Europe, etc but would include parts of asia (including significant parts of India).

What incentive is there to produce drugs when someone can copy them with impunity ?

Kennyboy66

Generali wrote: »

If you compare the NHS against the failing US system the NHS is clearly better. If you compare the NHS against all systems the NHS comes up as mediocre.

I'd agree with that - although the NHS stretches from the outstanding to the poor.

The problem with the health reforms is that the Tories look to the USA for inspiration - which ain't an enticing prospect.

They should have just continued the health competition reforms that Alan Milburn started but Andy Burnham (good Evertonian, bad health secretary) paused.

The only true way for forcing reforms will be some form of co-payment - the Australian system looks pretty attractive to me.

Ilya_Ilyich

Generali wrote: »

No difference to the patient.

The point is that the NHS basically doesn't charge except for prescriptions. From the patient's point of view, having ingrown toenails removed, pointlessly seeing a doctor when they have a cold and having cancer cured cost exactly the same, i.e. nothing. That actively encourages frivolous use of the medical system.

If I get a prescription filled I have a choice between the generic and the branded version (where both are available). I can have the branded one but only if I want to pay more. I pay $30 each time I visit the GP. As a result I can get a same-day appointment rather than wait for 2 weeks as I used to have to do in London in winter. Rationing in that case was being done by time rather than by price to the patient.

If you compare the NHS against the failing US system the NHS is clearly better. If you compare the NHS against all systems the NHS comes up as mediocre.

I agree that providing financial disincentives to seeking healthcare is a good way to reduce the amount of healthcare given and thereby increase healthcare availability to better-off patients. I'm not convinced that poors frivolously having their medical problems treated is something we need to combat.

Generali

Kennyboy66 wrote: »

I'd have thought that was trivial compared to the fact that the median age in the UK is 3 years older than that of Australia (2010). The proportion of over 65's in Australia 13.6%, in the UK it 16.8%

A huge difference when health costs are skewed to the the very young and the old.

In addition, amenable to health care does not just merely mean preventable by better treatment. It extends to death (under 75) by factors such as alcohol, tobacco and obesity.

Presumably the fact that the UK has an older median population means that there are more very old people in the UK and more very young people in Australia. Hypothermia is presumably more likely to kill a Briton than an Aussie. An Aussie is more likely to be bitten by a venomous snake or killed in a mining accident I would guess. Certainly, the roads in Australia are significantly more dangerous than in the UK.

The nature of a board like this is that arguments are going to be (over?) simplified and certainly, I am no expert in health economics. However, my experience and also the data seem to show that Australians are healthier than Britons on average, live longer and are more likely to survive infancy. The differences are quite significant, more than seems likely by noise, chance or sampling errors.

pqrdef

Kennyboy66 wrote: »

What incentive is there to produce drugs when someone can copy them with impunity ?

We all run the risk of being ill. It's not at all obvious that the fair way to fund progress in medical science is by charging £10 for a pill costing 10p to make.

It's not even a good system for the drug companies. They run huge risks in funding promising lines of work that don't pan out, and then there's the further risk of their new wonder drug being quickly superseded.

We need a whole different system of funding drug development.

Generali

Kennyboy66 wrote: »

I think (very broadly) the drug comanies can accept some generic drugs being used in Africa and other 3rd world areas.

The problem becomes when those drugs leak back into 'wealthy' markets, Europe, etc but would include parts of asia (including significant parts of India).

What incentive is there to produce drugs when someone can copy them with impunity ?

This is precisely the problem.

While morally it is 'fair' that poor people should have access to all medicines, if we accept that capitalism is a reasonable model to use for drug production then we have to accept that drug companies must be able to make a profit. They can only do this if they can charge enough of a premium to pay for their R&D costs: it costs very roughly £1,000,000,000 to bring a new drug to market. If drug companies can't profit from their existing drugs then they can't invent new ones.

IME, drug companies have a pretty good record overall in providing medicines cheaply to poorer countries.

pqrdef

Generali wrote: »

if we accept that capitalism is a reasonable model to use for drug production then we have to accept that drug companies must be able to make a profit. They can only do this if they can charge enough of a premium to pay for their R&D costs

Doesn't necessarily follow. For instance, a well-funded international body could buy the rights to successful drugs. The capitalists get their profit from selling the rights rather than selling the actual pills.

Kennyboy66

Generali wrote: »

Presumably the fact that the UK has an older median population means that there are more very old people in the UK and more very young people in Australia. .

Not really - birth rates in the 2 countries are very similar.

Where Australian stats would be dragged down would be Aboriginal peoples health and life expectancy.

The figures are dreadful almost as bad as parts of Glasgow!

Life expectancy in England is higher than the rest of the UK, so if Scotland becomes independent, we will all live longer. Hurray.